Monday, August 12, 2019

Empiric Antibiotics Regimens for Common Infections



Empiric Antibiotics Regimens for Common Infections

Infection
Common
Pathogens
Patient/Infection                Factors
Initial    Empiric Therapy
Options
Community acquired pneumonia
Streptococcus pneumoniae Haemophilus influenzae
Mycoplasma pneumoniae Chlamydophila pneumoniae
Legionella pneumophila
Outpatient,        otherwise                healthy, no                recent   antibiotic                exposure
Doxycycline        or                Azithromycin or                Clarithromycin


Outpatient,                comorbidities and/or  recent   antibiotic
exposure
Amoxicillin          or
Amoxicillin/Clavulanate or
Cefuroxime
-Plus-
Azithromycin     or
Clarithromycin
-OR-
Levofloxacin       or                Moxifloxacin or                Gemifloxacin


Inpatient,            non-ICU
Ceftriaxone        or                Cefotaxime        or
Ampicillin             or                Ertapenem
-Plus-
Azithromycin     or
Clarithromycin   or                Doxycycline
-OR-
Levofloxacin       or                Moxifloxacin


Inpatient,            ICU
Ceftriaxone        or                Cefotaxime        or
Ampicillin/Sulbactam
-Plus-
Azithromycin     or                Levofloxacin or                Moxifloxacin





Healthcare associated pneumonia
Streptococcus pneumoniae Haemophilus influenzae Staphylococcus aureus  (MSSA)
Escherichia                coli Klebsiella
pnueumoniae
Early-onset         (within  5                days       of hospitalization) and                no           recent antibiotic             exposure
Ceftriaxone        or
Ampicillin/Sulbactam      or
Ertapenem         or                Levofloxacin       or
Moxifloxacin

As           above                plus: Staphylococcus aureus  (MRSA) Enterobacter species Proteus species Serratia species
Pseudomonas aeruginosa
Late-onset          (after    5                days       of hospitalization) and/or                recent antibiotic                exposure
Cefepime            or                Ceftazidime        or
Imipenem           or                Meropenem      or
Piperacillin/Tazobactam or
Aztreonam
-Plus-
Ciprofloxacin      or                Levofloxacin or                Gentamicin         or                Tobramycin or                Amikacin
-Plus-
Vancomycin       or                Linezolid
Otitis   media
Viruses Streptococcus pneumoniae Haemophilus influenzae Moraxaella catarrhalis
Mild-moderate otalgia                with temperature                             39°C
Amoxicillin          or                Cefuroxime        or
Cefpodoxime     or                Azithromycin


Severe  otalgia   and/or temperature                      39°C
Amoxicillin/Clavulanate or
Ceftriaxone
Pharyngitis
Viruses Streptococcus pyogenes
Documented     or                high       risk         for
Streptococcus    pyogenes
Penicillin              VK          or                Cephalexin         or
Azithromycin
Urinary tract infections
Escherichia                coli Proteus species Klebsiella
pneumoniae
Staphylococcus
Uncomplicated                communityacquired             lower    urinary                tract infection   in                healthy women,                <
50           years     old
TMP/SMX           or                Nitrofurantoin   or
Fosfomycin         or
Ciprofloxacin      or                Levofloxacin


saphrophyticus Enterococcus species




Community-acquired complicated       urinary                tract infection   or                pyelonephritis
Ciprofloxacin      or                Levofloxacin or                Ceftriaxone        or                Ertapenem

As           above                plus: Enterobacter species
Pseudomonas aeruginosa
Nosocomial        complicated urinary  tract       infection                or pyelonephritis
Ceftazidime        or
Piperacillin/Tazobactam or
Cefepime            or                Meropenem      or
Imipenem
Skin/soft tissue infections
Streptococcus pyogenes Staphylococcus aureus
Low        risk         for          MRSA
Cefazolin             or                Nafcillin                or
Cephalexin         or                Dicloxacillin


High       risk         for          MRSA
Vancomycin       or                Linezolid              or
Clindamycin
-OR-
Cephalexin         or                Dicloxacillin
-Plus-
Doxycycline        or                TMP/SMX

As           above                plus:
Escherichia                coli Proteus species Klebsiella
pneumoniae Bacteroides
fragilis
Enterococcus species
Pseudomonas aeruginosa
Diabetic                foot                infection, moderate                to            severe
Ceftriaxone        or
Ampicillin/Sulbactam      or
Piperacillin/Tazobactam or
Ertapenem
-OR-
Levofloxacin       or                Ciprofloxacin
-Plus-
Clindamycin
All           WITH     or                WITHOUT
Vancomycin
Intra-
abdominal infections
Escherichia                coli Proteus species
Klebsiella
Community-acquired,                mildmoderate                severity
Ertapenem         or                Moxifloxacin      or
Tigecycline
-OR-
Cefazolin             or                Ceftriaxone        or



pneumoniae Bacteroides fragilis
Enterococcus species viridans
Streptococcus

Levofloxacin       or                Ciprofloxacin
-Plus-
Metronidazole

As           above                plus:
Pseudomonas aeruginosa Enterobacter spp
Serratia spp
Community-acquired,                high severity                or            high-risk                patient
-OR-
Nosocomial        (any                severity or patient)
Piperacillin/Tazobactam or
Imipenem           or                Meropenem
-OR-
Ceftazidime        or                Cefepime
-Plus-
Metronidazole
All           WITH     or                WITHOUT
Vancomycin
Community acquired meningitis
Streptococcus pneumoniae Neisseria meningitidis
Otherwise           healthy,                2–50      years of                age
Ceftriaxone
-Plus-
Vancomycin

As           above                plus: Listeria
monocytogenes
>             50           years                of            age                or
immunocompromised
Ceftriaxone
-Plus-
Vancomycin
-PlusAmpicillin
Healthcare associated infectious diarrhea
Clostridium
difficile
Mild-moderate infection
Metronidazole  (oral)


Severe  infection
Vancomycin       (oral)     or
Fidaxomicin


Severe, complicated                infection
(e.g.,     ileus)
Vancomycin       (oral)
-Plus-
Intravenous                metronidazole
Community acquired infectious
Shigella
Salmonella
Escherichia                coli
See        above
Fluoroquinolone              or                TMP/SMX
if             antibiotic                therapy is
necessary

diarrhea
Campylobacter Clostridium
difficile
(uncommon)



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